Endoscopic purse string suture surgical device

ABSTRACT

A surgical stapler for applying a suture to tissue includes a first jaw and a second jaw configured to receive a cartridge. An actuation mechanism translates a drive member distally through the first and second jaws to apply staples to tissue such that a suture, in combination with the staples, forms a purse string when the stapler activated. The cartridge includes a first upper portion and a second lower portion.

BACKGROUND

Surgical anastomosis joins together two hollow organs, usually torestore continuity after resection, or less commonly to bypass anunresectable disease process. Anastomosis is typically performed onblood vessels including arteries and veins; gastrointestinal tractincluding esophagus, stomach, small intestine, colon, rectum, anus, bileducts and pancreas; or urinary tract including ureters, urinary bladderand urethra, and fallopian tubes.

Purse string sutures and purse string appliers may be used duringanastomosis procedures. A suture is typically placed using a needle,staples or other suitable means for attaching the suture to the tissue.After attachment, the ends of the suture remain loose for pulling tocontract or close the tissue.

In minimally invasive, e.g. endoscopic, surgical anastomosis procedures,it would be advantageous to provide an endoscopic purse string devicewhich could apply purse string sutures in a minimally invasive mannerand that is compatible with a robotic surgical system.

SUMMARY

The following presents a simplified summary of the claimed subjectmatter in order to provide a basic understanding of some aspects of theclaimed subject matter. This summary is not an extensive overview of theclaimed subject matter. It is intended to neither identify key orcritical elements of the claimed subject matter nor delineate the scopeof the claimed subject matter. Its sole purpose is to present someconcepts of the claimed subject matter in a simplified form as a preludeto the more detailed description that is presented later.

The present disclosure relates to surgical staplers for applying asuture to tissue having a cartridge including a shuttle configured toengage a series of staple drivers for ejecting staples upon distaltranslation of a drive member.

In another aspect, the present disclosure relates to surgical staplersfor applying a suture to tissue including a cartridge having a firstupper portion and a second lower portion connected by a connectingmember and configured to be installed along the longitudinal axis of theend effector.

In another aspect, the present disclosure relates to a jaw-closingmechanism having a first and second link member secured to a first andsecond jaw, the first and second links coupled with a first and secondpair of drive cables configured to apply force to the first and secondlink members to cause them to rotate about pivot pins and ride through acam slot having a proximal portion for parallel closure of the jaws anda distal portion for angular closure of the jaws.

In embodiments, a surgical stapler for applying a suture to tissue inaccordance with this disclosure includes an elongated shaft having adistal end and a proximal end. The end effector defines a longitudinalaxis and includes a first jaw and a second jaw. The first jaw and secondjaw are configured to receive a cartridge and to move from an openposition to a closed position to apply staples to tissue such that asuture, in combination with the staples, form a purse string with thetissue when the stapler is activated. The surgical stapler furtherincludes a drive member configured to translate distally and retractproximally through the end effector, and an actuation mechanismconfigured to translate the drive member distally through the endeffector and retract the drive member proximally through the endeffector. The cartridge includes a first upper portion configured to fitinto the first jaw and a second lower portion configured to fit into thesecond jaw. The cartridge further includes a shuttle configured toengage a series of staple drivers for ejecting staples upon distaltranslation of the drive member In embodiments, the first upper portionand second lower portion are connected by a connecting member, and thecartridge is configured to be installed along the longitudinal axis ofthe end effector.

In another aspect, a jaw-closing mechanism for a surgical stapler forapplying suture to tissue in accordance with this disclosure relates toa first link member and a second link member. The first and second linkmembers are configured to rotate about a pair of pivot pins uponapplication of force to the first and second link members. A pair ofouter pins are configured to secure the first and second link members toa first jaw and a second jaw. A first and second pair of drive cablesare configured to apply force to the first and second links to causerotation about the pivot pins. The jaw-closing mechanism furtherincludes a cam slot formed on one of the jaws configured to accept a camslot pin of at least one of the link members. The cam slot has aproximal portion for parallel closure of the jaws, and a distal portionfor angular closure of the jaws.

BRIEF DESCRIPTION OF THE DRAWINGS

The above and other aspects, features, and advantages of the presentsurgical instruments will become more apparent in light of the followingdetailed description when taken in conjunction with the accompanyingdrawings in which:

FIG. 1 is a perspective view of an illustrative surgical instrument inaccordance with the present disclosure;

FIG. 1A is a perspective view of the distal end portion of the surgicalinstrument of FIG. 1 shown having an end effector mounted to anelongated shaft and a backend mechanism configured to actuate theinstrument;

FIG. 2 is a perspective exploded view of a staple cartridge suitable foruse with the surgical instrument of FIG. 1;

FIG. 2A is a perspective view showing installation of a cartridge intothe surgical instrument of FIG. 1;

FIG. 2B illustrates a portion of an illustrative surgical instrument inaccordance with this disclosure having a flexing latch;

FIG. 2C illustrates a portion of an illustrative cartridge suitable foruse with the surgical instrument of FIG. 1;

FIG. 2D illustrates an illustrative jaw suitable for use with thesurgical instrument of FIG. 1 having hooks configured to engage andretain the cartridge of FIG. 2C within the jaws;

FIG. 2E illustrates an exploded view of another illustrative jaw andcartridge suitable for use with the surgical instrument of FIG. 1;

FIG. 3 is a partial perspective view of a portion of the end effectorwith a fresh reload installed;

FIG. 4 is a perspective view of the distal end portion of the surgicalinstrument of FIG. 1 with the jaws in the angled open position;

FIG. 5 is a perspective view of the distal end portion of the surgicalinstrument of FIG. 1 with the jaws in the parallel position;

FIG. 6 is a perspective view of the distal end portion of the surgicalinstrument of FIG. 1 with the jaws in the completely closed position;

FIG. 7 is a cross-sectional perspective view of the jaw closuremechanism of the surgical instrument of FIG. 1;

FIG. 8 is a perspective view of the first and second links of the jawclosure mechanism;

FIG. 9 is a perspective view of a portion of a jaw of the surgicalinstrument of FIG. 1;

FIG. 10 is a perspective view of the articulation mechanism of thesurgical instrument of FIG. 1 with parts removed to reveal internalstructures;

FIG. 11 is a perspective view of the shuttle of the surgical instrumentof FIG. 1;

FIG. 11A is a partial perspective view with parts removed showing anunfired cartridge installed in the surgical instrument of FIG. 1;

FIG. 12 is a cross-sectional perspective view of the drive mechanism ofthe surgical instrument of FIG. 1 with parts removed showing a drivemember configured to drive distally upon actuation;

FIG. 13 is a partial perspective view with parts removed of a partiallydriven shuttle contacting a staple driver as it moves distally uponactuation;

FIGS. 13A and 13 B schematically show the firing of a staple to capturethe suture and form a purse string;

FIG. 14 depicts an illustrative vessel that has been severed and securedwith a series of staples combined with sutures to form purse strings;

FIG. 15 depicts a locking mechanism suitable for use in the surgicalinstrument of FIG. 1 in a disabled configuration;

FIG. 16 depicts the locking mechanism of FIG. 15 in an enabledconfiguration;

FIG. 17 illustrates a top view of an operating room employing a roboticsurgical system utilizing aspects of the present disclosure; and

FIG. 18 illustrates a simplified side view of a robotic arm assemblythat is usable with various aspects of the present disclosure.

DETAILED DESCRIPTION

Particular embodiments of the present surgical instruments are describedhereinbelow with reference to the accompanying drawings; however, it isto be understood that the disclosed embodiments are merely exemplary ofthe disclosure and may be embodied in various forms. Therefore, specificstructural and functional details disclosed herein are not to beinterpreted as limiting, but merely as a basis for the claims and as arepresentative basis for teaching one skilled in the art to variouslyemploy the present disclosure in virtually any appropriately detailedstructure. Well-known functions or constructions are not described indetail to avoid obscuring the present disclosure in any unnecessarydetail.

While the following disclosure is presented with respect to a surgicalinstrument for forming purse strings, it should be understood thatcertain features of the presently described surgical instruments may bereadily adapted for use in any type of surgical clamping, cutting, orsealing instruments. The surgical clamping and cutting instrument may bea minimally invasive (e.g., laparoscopic) instrument or an instrumentused for open surgery.

Additionally, the features of the presently described surgical staplinginstruments may be readily adapted for use in surgical instruments thatare activated using any technique within the purview of those skilled inthe art, such as, for example, manually activated surgical instruments,powered surgical instruments (e.g., electro-mechanically poweredinstruments), robotic surgical instruments, and the like.

FIG. 1 is a perspective view of an illustrative surgical instrument 100in accordance with embodiments of the present disclosure having abackend mechanism 120, and an end effector 110 mounted on an elongatedshaft 106. Backend mechanism 120 typically provides a mechanicalcoupling between the drive tendons or cables of the instrument andmotorized axes of the mechanical interface of a drive system. Furtherdetails of known backend mechanisms and surgical systems are described,for example, in U.S. Pat. Nos. 8,597,280, 7,048,745, and 10,016,244.Each of these patents is hereby incorporated by reference in itsentirety.

Actuation mechanisms of surgical instrument 100 employ drive cables thatare used in conjunction with a system of motors and pulleys. Poweredsurgical systems, including robotic surgical systems that utilize drivecables connected to a system of motors and pulleys for various functionsincluding opening and closing of jaws, as well as for movement andactuation of end effectors are well known. Further details of knowndrive cable surgical systems are described, for example, in U.S. Pat.Nos. 7,666,191 and 9,050,119 both of which are hereby incorporated byreference in their entireties.

FIG. 1A shows the distal end portion of surgical instrument 100,including an end effector 110 defining a longitudinal axis X-X andhaving a first jaw 111, a second jaw 112, a cartridge 122, a clevis 140for mounting jaws 111, 112 to the instrument, and an articulationmechanism, such as wrist 160. First and second jaws 111, 112 areconfigured to move from an open position to a closed position. In theclosed position, jaws 111, 112 cooperate to clamp tissue.

FIG. 2 depicts cartridge 122. In embodiments, cartridge 122 includes anupper portion 123 having a first and second side 123 a, 123 b, and alower portion 124 having a first and second side 124 a, 124 b. Each pairof first and second sides 123 a, 123 b and 124 a, 124 b is separated bya center knife channel 153. Each side 123 a, 123 b and 124 a, 124 bdefines a tissue contacting surface 198 a, 198 b and 198 c, 198 d havingstaple retaining pockets 128 and a suture retaining channel 159 a-dformed therein. (See also FIG. 3.) In embodiments, tissue contactingsurfaces 198 a-d may further include protrusions (not shown) positionedabout staple receiving pockets 128. Protrusions help to further secureclamped tissue and to resist movement that might be induced from forcescreated by the severing and stapling of clamped tissue. Staples 126 aresupported on corresponding staple drivers 127 provided within respectivestaple receiving pockets 128 formed in cartridge 122. Staple receivingpockets 128 may be cutouts that are substantially perpendicular to thelongitudinal axis of end effector 110, and similar in length to thedesired size of staples 126 to be fired. Each staple 126 include legs157 and a backspan 158. Suture retaining channels 159 a-d runsubstantially parallel to the longitudinal axis of end effector 110 andare substantially aligned with the center of staple receiving pockets128 so that upon firing of staples 126, sutures 129 a, 129 b arecaptured at various locations between staples 126 and tissue 197 asdescribed in more detail below.

Upper portion 123 and lower portion 124 of cartridge 122 are configuredto be contained within first jaw 111 and second jaw 112, respectively.Side 123 a of upper portion 123 is connected to side 124 a of lowerportion 124 at the proximal end of cartridge 122 by living hinge 125 a.Likewise, side 123 b of upper portion 123 is connected to side 124 b oflower portion 124 at the proximal end of cartridge 122 by living hinge125 b. Channels 159 a, 159 c of sides 123 a and 124 a of cartridge 122extend to living hinge 125 a and align with living hinge channel 169 a.Likewise, channels 159 b, 159 d of sides 123 b and 124 b of cartridge122 extend to living hinge 125 b and align with living hinge channel 169b. In this manner, sutures 129 a, 129 b may be guided from lower portion124 to upper portion 123 on each side of the instrument to form a loopupon clamping of tissue and actuation of the surgical instrument.

Cartridge 122 also may include a shuttle 130 having an inclined distalportion 131 that, upon distal movement, sequentially acts on stapledrivers 127, camming them towards grasped tissue thereby forcing thestaples towards grasped tissue. Legs 157 of staples 126 are positionedon either side of sutures 129 a, 129 b, and are configured to securesutures 129 a, 129 b to grasped tissue upon actuation of the surgicalinstrument. Details of the mechanism for formation of staples 126 toprovide purse strings are described below. (See FIGS. 13 and 13A.)

In embodiments, upper portion 123 of cartridge 122 includes distal endportion 190 that, upon closing of jaws 111, 112, overlaps a distal endportion 195 of lower portion 124. Distal end portion 190 preventscartridge 122 from sliding out of the jaws after installation. Distalend portion 190 may include a flexing latch member 192, that uponinstallation of cartridge 122 in jaws 111, 112 would engage with arecess (not shown) contained within jaw 111, retaining latch member 192in place until defeated by application of finger pressure to release it.Flexure would provide an over-center snap feeling between the latchedand the unlatched position, such that a surgeon would be able to feelthe difference between the latched and unlatched positions. It isenvisioned that latch 192 may be held in place by any number of desiredmating features, such as a protrusion, or a cutout formed on jaw 111. Inan alternative embodiment shown in FIGS. 2C-2D cartridge 122 may furtherinclude cutouts 199 a configured to engage at least one hook 199 bcontained within jaws 111, 112. Upon installation, cartridge 122 mayslightly pivot such that hooks 199 b catch within recesses 199 a helpingto retain the cartridge 122 in place.

Distal end portions 129 c of suture 129 a extend beyond the distal endsof suture retaining slots 159 a and 159 c and distal end portions 129 dof suture 129 b extend beyond the distal ends of suture retaining slots159 b and 159 d. Thus, suture 129 a may, for example, extend from distalend portion 190, extending proximally in channel 159 a within side 123 aof upper portion 123 of cartridge 122, around living hinge 125 a throughliving hinge channel 169 a, and then extend distally along suturechannel 159 c of side 124 a of lower portion 124 of cartridge 122.Cartridge 122 is installed in a direction substantially parallel to thelongitudinal axis of end effector 110, and is inserted in the directionof arrow A from the distal end of surgical instrument 100 towards theproximal end of surgical instrument 100, as shown in FIG. 2A. Inalternative embodiments, it is envisioned that the stapler may allow forinstallation of cartridge 122 in a radial direction that issubstantially orthogonal to the longitudinal axis of end effector 110.FIG. 2E shows an illustrative jaw 112 configured to allow for radialinstallation of cartridge 122. Hooks 199 b on the cartridge may engagerecesses 199 a formed on jaw 112 to help retain cartridge 122 within jaw111 in a similar manner as previously described embodiments.

As seen in FIG. 3, when a fresh unfired cartridge 122 is installed,shuttle 130 prevents unwanted separation of sides 123 a and 123 b ofupper portion 123 of cartridge 122 and of sides 124 a and 124 b of lowerportion 124 of cartridge 122. Additionally, cartridge 122 includesprotrusions 121 configured to slide into slots 113 formed on jaws 111,112. Slots 113 of jaws 111, 112 serve as guide rails for protrusions 121to ensure proper alignment upon installation of a fresh cartridge 122.Additionally, the interaction of cartridge protrusions 121 and slots 113limits upward and downward movement of cartridge 122 during installationand firing.

FIGS. 4-6 depict the movement of jaws 111, 112 as the instrument isclosed in preparation for actuation.

In FIG. 4, jaws 111, 112 are in an open position, resembling a grasper,and are in an angled-closure zone. Jaws 111, 112 close angularly untilthey are substantially parallel, as shown in FIG. 5. Once jaws 111, 112are substantially parallel they continue to close while remainingsubstantially parallel to compress tissue. Once closed about tissue, theinstrument may be fired to cut and insert staples into the graspedtissue, while causing sutures 129 a, 129 b to be captured by the staplesform a purse string around the clamped tissue. The mechanism by whichthe jaws are opened and closed are described in more detail below.

FIG. 7 shows a portion of surgical instrument 100 configured to open andclose the jaws including clevis 140, first link member 145, second linkmember 146, and drive cables 170 a, 170 b.

As shown in FIG. 7, two drive cables 170 a, 170 b route symmetrically tothe backend of surgical instrument 100, and terminate in a knot 172within the proximal end 141 of a first link member 145. As cables 170 a,170 b are pulled by the force of the motor (not shown) or via some othermechanism, first link member 145 rotates about pivot pin 143 on clevis140, causing a second link member 146 to rotate about pivot pin 144 onclevis 140, thereby moving the jaws towards an open or closed positiondepending on which drive cable was pulled. The resulting jaw force issubstantially similar to the cable pull force. One of ordinary skillwill appreciate that a pair of drive cables may be present on each side,of surgical instrument 100, each pair of drive cables including a firstcable for closing a first link, and a second cable for opening the firstlink. Using four cables in total for opening and closing of the jawreduces the stress on each cable, and allows for symmetrically balancedcable forces through the wrist 160 such that actuating the jaw does notimpart pitch or yaw forces into the wrist. (See FIG. 10.)

As illustrated in FIGS. 8 and 9, link member 145 includes upper outerpin 148 a, and link member 146 includes lower outer pin 148 b. Upperouter pin 148 a is configured to be positioned within opening 114 of jaw111, while lower outer pin 148 b is configured to be positioned withinan opening 115 of jaw 112. (See, e.g., FIGS. 1A and 4-6.) Link member145 also include cam slot pin 149 a configured to engage and ride withincam slot 118 formed on jaw 111. Cam slot 118 is designed such that theproximal portion 118 a of cam slot 118 allows for parallel closure ofjaw 111, while the distal portion 118 b of cam slot 118 allows forangular closure of jaws 111 upon rotation of link members 145, 146 dueto the force of drive cables 170 a, 170 b upon actuation of the surgicalinstrument. A second set of link members 145 a, 145 b and correspondingopenings and cam slot, similar to link members 145, 146 is present onthe far side of clevis 140 jaws 111, 112 and function similarly to linkmembers 145, 146. Links members 145, 146 also include gear teeth 147 toenforce equally symmetric motion of jaws 111,112.

FIG. 10 illustrates the articulation mechanism including an articulatingwrist 160, and drive cables 170 c, 170 d running from the proximal endof the instrument to wrist links 162, 164. Wrist 160 includes a numberof links that provide a desired amount of motion, such as +/−90 degreesin a pitch or yaw direction. In embodiments, a single joint can provideup to a 90 degree angular deflection. According to an exemplaryembodiment, a wrist may include a plurality of links to achieve higherranges of motion, such as, for example, wrists having a range of motionof up to +/−180 degrees in a pitch or yaw direction. Typically,actuation elements such as, for example, pull/pull tendons or push/pullrods, and electrical conductors that are connected to a wrist and/or endeffector of an instrument may extend through the elongated shaft of theinstrument. Further, the actuation elements may extend through theelongated shaft and connect to a transmission mechanism that typicallyprovides a mechanical coupling of the drive tendons to drive motors. Asnoted above, surgical instrument 100 may include two pairs of drivecables for opening and closing of the jaws, reducing the stress on eachcable, and allowing for symmetrically balanced cable forces throughwrist 160 such that actuating the jaw does not impart pitch or yawforces into the wrist. Additionally, it is envisioned that the cablesmay merge within the mid-section of surgical instrument 100 such thatonly two cables are presented at the input capstans (not shown). Thistype of merging allows for a pulley to maintain cable lengthconservation as the wrist pitches or yaws. Additional details of otherjoints and wrist actuation elements usable with the embodimentsdisclosed herein, are disclosed in Int'l. Pub. No. WO 2015/127250A1, theentire disclosure of which is incorporated by reference herein.

FIGS. 11 and 11A show shuttles 130 contained in cartridge 122. Eachshuttle 130 has a body 135 including inclined distal portions 131 andwings 137, 138. A shuttle 130 is positioned in each of upper and lowerportions 123, 124 of cartridge 122 and prevent first side 123 a andsecond side 123 b of upper portion 123 and first side 124 a and secondside 124 b of lower portion 124 from splaying during handling to ensurethat cartridge 122 fits within slots 113 of jaws 111, 112. (See FIG.11A.) Upon distal movement of shuttle 130, inclined distal portions 131sequentially act on staple drivers 127, camming them upwardly therebyforcing staples 126 through staple receiving pockets 128. Shuttle 130also includes proximal faces 132 that may be substantially perpendicularto the axis of end effector 110. Leading edge 133 of shuttle 130 herdstissue toward the center knife channel 153 so that the tissue may besevered by knife 151. (See FIG. 13.) Shuttle 130 also includes inneredge 134 which is described in further detail below. (See FIG. 15.)

FIGS. 12-13 illustrate distal translation of the components of surgicalinstrument 100 upon actuation to sever and insert staples into clampedtissue such that a purse string is formed by sutures 129 a, 129 b.

FIG. 12 shows a drive member 150 having an integrated knife edge 151,shuttles 130, clevis 140, and drive rod 155. Upon actuation of surgicalinstrument 100, drive member 150 is pushed distally or pulled proximallythrough center knife channel 153 of cartridge 122 by drive rod 155 thatis secured to a proximal cutout 154 formed on drive member 150. Drivemember 150 may be coupled to any known actuation mechanisms includingmanually-activated actuators, motor-driven or powered actuators, orother types of actuation mechanisms. Drive member 150 includes distaledges 152 that are substantially aligned with proximal faces 132 ofshuttle 130. Upon actuation of surgical instrument 100, distal edges 152of drive member 150 engage proximal faces 132 of shuttle 130 translatingshuttle 130 distally. Drive member 150 also includes knife edge 151positioned between distal edges 152 for severing clamped tissue upondistal translation of drive member 150 through center knife channel 153during firing of surgical instrument 100. The central position of knifechannel 153 ensures that knife edge 151 severs tissue that is adjacentto and between the two portions of tissue that are stapled and sutured.(See FIG. 14.)

FIG. 13 shows shuttle 130 traveling distally during firing of surgicalinstrument 100. In FIG. 13, inclined distal portion 131 of shuttle 130has fully deployed a first staple 126 a and is engaging a second stapledriver 127 to deploy a second staple 126 b. As seen in FIGS. 13A and13B, initially, each staple 126 is pushed under a force applied by astaple driver 127 to the backspan 158 of the staple while lateral forcesare simultaneously applied against the legs 156 by the lips 157 ofstaple receiving pockets 128 so that the legs 156 begin to deform andmove towards each other while penetrating into tissue 197. As depictedin FIG. 13B near the end of each stroke of staple drivers 127 the legs156 of a staple have been substantially deformed so as to be in crossingrelation to each other. In this position, the staples will not readilypull out from tissue 197. At the same time, sutures 129 a, 129 b arepushed out of channels 159 a-d and are captured between the deformedstaples 126 and tissue 197. Sutures 129 form a purse string as they areretained within the deformed staples 126.

FIG. 14 depicts an illustrative blood vessel or tissue that has beensevered and stapled with a surgical instrument in accordance with thisdisclosure. Sutures 129 a, 129 b have been secured to the tissue in apurse string formation with staples 126 holding sutures 129 a, 129 b inplace. Once secured, another instrument may be used to cinch the pursestring tight by pulling on the ends 129 c, 129 d. In embodiments, aclips 165 a, 165 b may be preloaded into distal end of cartridge 122 andsecured to the ends 129 c, 129 d of sutures 129 a, 129 b and used toallow a surgeon to cinch the purse string tight by hand to retain thesutures 129 a, 129 b in the cinched configuration.

FIGS. 15 and 16 show a lockout mechanism that may be used with surgicalinstruments in accordance with embodiments of this disclosure.

In FIG. 15, a disabled locking mechanism is shown. Locking member 180has an engagement portion 181 on the distal end of locking member 180,and a proximal portion 182 on the proximal end of locking member 180. Inembodiments, distal portion 181 of locking member 180 is shaped like ahook. In embodiments, locking member 180 is formed from spring wire.When an unfired cartridge is installed, inner edge 134 of shuttle 130contacts engagement portion 181 of locking member 180, keeping it out ofalignment with distal edges 152 of drive member 150. In this position,drive member 150 may be translated distally allowing a user to actuatethe instrument.

FIG. 16 shows an enabled locking mechanism. Locking member 180 isdesigned such that engagement portion 181 is biased towards a positionthat aligns engagement portion 181 with distal edges 152 of drive member150. As seen in FIG. 16, when shuttle 130 is moved and inner edge 134 ofshuttle 130 no longer contacts locking member 180, engagement portion181 of locking member 180 moves back to its naturally biased position,where it is aligned with distal edges 152 of drive member 150. Once theinstrument is fired and retraction of drive member 150 occurs, a usermay not fire the instrument again without installing a fresh unfiredcartridge, as distal edges 152 will contact engagement portion 181 oflocking member 180 and the drive member 150 will be prevented fromtranslating distally unless a fresh cartridge is installed, and the jawshave closed sufficiently such that they are parallel and clamped ontissue.

The present surgical instrument for applying one or more purse stringsutures may be used in a robotic surgical system. FIG. 17 illustrates,as an example, a top view of an operating room employing a roboticsurgical system. The robotic surgical system in this case is a roboticsurgical system 300 including a Console (“C”) utilized by a Surgeon(“S”) while performing a minimally invasive diagnostic or surgicalprocedure, usually with assistance from one or more Assistants (“A”), ona Patient (“P”) who is lying down on an Operating table (“O”).

The Console includes a monitor 304 for displaying an image of a surgicalsite to the Surgeon, left and right manipulatable control devices 308and 309, a foot pedal 305, and a processor 302. The control devices 308and 309 may include any one or more of a variety of input devices suchas joysticks, gloves, trigger-guns, hand-operated controllers, or thelike. The processor 302 may be a dedicated computer that may beintegrated into the Console or positioned next to it.

The Surgeon performs a minimally invasive surgical procedure bymanipulating the control devices 308 and 309 (also referred to herein as“master manipulators”) so that the processor 302 causes theirrespectively associated robotic arm assemblies, 328 and 329, (alsoreferred to herein as “slave manipulators”) to manipulate theirrespective removably coupled surgical instruments 338 and 339 (alsoreferred to herein as “tools”) accordingly, while the Surgeon views thesurgical site in 3-D on the Console monitor 304 as it is captured by astereoscopic endoscope 340.

Each of the tools 338 and 339, as well as the endoscope 340, may beinserted through a cannula or other tool guide (not shown) into thePatient so as to extend down to the surgical site through acorresponding minimally invasive incision such as incision 366. Each ofthe robotic arms is conventionally formed of links, such as link 362,which are coupled together and manipulated through motor controlled oractive joints, such as joint 363.

The number of surgical tools used at one time and consequently, thenumber of robotic arms being used in the system 300 will generallydepend on the diagnostic or surgical procedure and the space constraintswithin the operating room, among other factors. If it is necessary tochange one or more of the tools being used during a procedure, theAssistant may remove the tool no longer being used from its robotic arm,and replace it with another tool 331 from a Tray (“T”) in the operatingroom.

The monitor 304 may be positioned near the Surgeon's hands so that itwill display a projected image that is oriented so that the Surgeonfeels that he or she is actually looking directly down onto theoperating site. To that end, images of the tools 338 and 339 may appearto be located substantially where the Surgeon's hands are located.

The processor 302 performs various functions in the system 300. Oneimportant function that it performs is to translate and transfer themechanical motion of control devices 308 and 309 to their respectiverobotic arms 328 and 329 through control signals over bus 310 so thatthe Surgeon can effectively manipulate their respective tools 338 and339. Another important function is to implement various control systemprocesses as described herein.

Although described as a processor, it is to be appreciated that theprocessor 302 may be implemented in practice by any combination ofhardware, software and firmware. Also, its functions as described hereinmay be performed by one unit, or divided up among different components,each of which may be implemented in turn by any combination of hardware,software and firmware.

For additional details on robotic surgical systems, see, e.g., U.S. Pat.Nos. 6,493,608 and 6,671,581, the entire contents of which areincorporated herein by this reference.

FIG. 18 illustrates, as an example, a side view of a simplified (notnecessarily in proportion or complete) illustrative robotic arm assembly400 (which is representative of robotic arm assemblies 328 and 329)holding a surgical instrument 450 (which is representative of tools 338and 339) for performing a surgical procedure. The surgical instrument450 is removably held in tool holder 440. The arm assembly 400 ismechanically supported by a base 401, which may be part of apatient-side movable cart or affixed to the operating table or ceiling.It includes links 402 and 403 which are coupled together and to the base401 through setup joints 404 and 405.

The setup joints 404 and 405 in this example are passive joints thatallow manual positioning of the arm 400 when their brakes are released.For example, setup joint 404 allows link 402 to be manually rotatedabout axis 406, and setup joint 405 allows link 403 to be manuallyrotated about axis 407.

Although only two links and two setup joints are shown in this example,more or less of each may be used as appropriate in this and otherrobotic arm assemblies in conjunction with the present invention. Forexample, although setup joints 404 and 405 are useful for horizontalpositioning of the arm 400, additional setup joints may be included anduseful for limited vertical and angular positioning of the arm 400. Formajor vertical positioning of the arm 400, however, the arm 400 may alsobe slidably moved along the vertical axis of the base 401 and locked inposition.

The robotic arm assembly 400 also includes three active joints driven bymotors. A yaw joint 410 allows arm section 430 to rotate around an axis461, and a pitch joint 420 allows arm section 430 to rotate about anaxis perpendicular to that of axis 461 and orthogonal to the plane ofthe drawing. The arm section 430 is configured so that sections 431 and432 are always parallel to each other as the pitch joint 420 is rotatedby its motor. As a consequence, the instrument 450 may be controllablymoved by driving the yaw and pitch motors so as to pivot about the pivotpoint 462, which is generally located through manual positioning of thesetup joints 404 and 405 so as to be at the point of incision into thepatient. In addition, an insertion gear 445 may be coupled to a lineardrive mechanism (not shown) to extend or retract the instrument 450along its axis 463.

Although each of the yaw, pitch and insertion joints or gears, 410, 420and 445, is controlled by an individual joint or gear controller, thethree controllers are controlled by a common master/slave control systemso that the robotic arm assembly 400 (also referred to herein as a“slave manipulator”) may be controlled through user (e.g., surgeon)manipulation of its associated master manipulator.

While several embodiments have been shown in the drawings, it is notintended that the disclosure be limited thereto, as it is intended thatthe disclosure be as broad in scope as the art will allow and that thespecification be read likewise. Therefore, the above description shouldnot be construed as limiting, but merely as exemplifications ofpresently disclosed embodiments. Thus, the scope of the embodimentsshould be determined by the appended claims and their legal equivalents,rather than by the examples given.

Persons skilled in the art will understand that the devices and methodsspecifically described herein and illustrated in the accompanyingdrawings are non-limiting exemplary embodiments. The featuresillustrated or described in connection with one exemplary embodiment maybe combined with the features of other embodiments. Various alternativesand modifications can be devised by those skilled in the art withoutdeparting from the disclosure. Accordingly, the present disclosure isintended to embrace all such alternatives, modifications and variances.As well, one skilled in the art will appreciate further features andadvantages of the present disclosure based on the above-describedembodiments. Accordingly, the present disclosure is not to be limited bywhat has been particularly shown and described, except as indicated bythe appended claims.

1. A surgical stapler for applying a suture to tissue, the surgicalstapler comprising: an elongated shaft having a distal end and aproximal end; an end effector having first and second jaws configured tomove from an open position to a closed position; a cartridge removablycoupled to the end effector and having a first upper portion sized tofit into the first jaw and a second lower portion sized to fit into thesecond jaw; a drive member configured to translate distally through theend effector to apply staples and a suture to tissue and; an actuationmechanism configured to translate the drive member distally through theend effector.
 2. The surgical stapler of claim 1, wherein the drivemember is configured to engage a plurality of staple drivers in thecartridge for ejecting staples such that the suture, in combination withthe staples, forms a purse string with the tissue.
 3. The surgicalstapler of claim 2, wherein the cartridge further includes a connectingmember between the first upper portion and the second lower portion. 4.The surgical stapler of claim 1, wherein the first and second portionsof the cartridge each include two rows of staples and are configured forinstallation upon a longitudinal axis of the end effector.
 5. Thesurgical stapler of claim 3, wherein the connecting member comprises aliving hinge.
 6. The surgical stapler of claim 5, wherein the livinghinge comprises a channel for receiving the suture, wherein the channelis configured to form the suture into a loop.
 7. The surgical stapler ofclaim 1, wherein the cartridge further comprises a distal portionconfigured to retain the cartridge in the first and second jaws.
 8. Thesurgical stapler of claim 1, wherein the first and second jaws areconfigured to move from the open position, to a partially closedposition, wherein the jaws are substantially parallel with each otherand define a gap therebetween.
 9. The surgical stapler of claim 8,wherein the first and second jaws include cam slots having a firstjaw-closing portion for allowing the jaws to move from the open positionto the partially open position and second jaw-closing portion forallowing the jaws to move from the partially open position to the closedposition.
 10. The surgical stapler of claim 1 further comprising anactuator operatively connected to the actuation mechanism, wherein theactuator includes a control device of a robotic surgical system.
 11. Asurgical stapler for applying a suture to tissue, the surgical staplercomprising: an elongated shaft having distal and proximal ends; an endeffector having first and second jaws configured to receive a cartridge;a drive member configured to translate distally through the end effectorto apply staples and a suture to tissue; an actuation mechanismconfigured to translate the drive member distally through the endeffector; and wherein the first and second jaws are movable between anopen position, wherein the jaws define an angle therebetween, to apartially closed position, wherein the jaws are substantially parallelwith each other and define a gap therebetween, to a closed position,wherein the jaw are substantially parallel to each other.
 12. Thesurgical stapler of claim 11, wherein at least one of the first andsecond jaws includes a cam slot having a first jaw-closing portion forallowing the jaws to move from the open position to the partially openposition and second jaw-closing portion for allowing the jaws to movefrom the partially open position to the closed position.
 13. Thesurgical stapler of claim 12, wherein the end effector defines alongitudinal axis and wherein the first jaw-closing portion of the camslot extends at a transverse angle to the longitudinal axis and thesecond jaw-closing portion of the cam slot is substantially parallel tothe longitudinal axis.
 14. The surgical stapler of claim 12, furthercomprising: at least one link member configured to rotate about at leastone pivot pin upon application of force to the link member; and a camslot pin extending from the link member and through the cam slot,wherein the cam slot pin is configured to translate through the cam slotupon rotation of the link member.
 15. The surgical stapler of claim 14,further comprising a drive cable configured to apply a force to the linkmember to cause rotation about the pivot pin.
 16. The surgical staplerof claim 14, wherein the cam slot is disposed in the second jaw, thefirst jaw comprising a pivot hole and the link member comprising aproximal pin that extends through the pivot hole.
 17. The surgicalstapler of claim 11, wherein the drive member is configured to engage aplurality of staple drivers in the cartridge for ejecting the staplessuch that the suture, in combination with the staples, forms a pursestring with the tissue.
 18. The surgical stapler of claim 11 furthercomprising an actuator operatively connected to the actuation mechanism,wherein the actuator includes a control device of a robotic surgicalsystem.
 19. The surgical stapler of claim 12, wherein the drive memberengages the staples as the jaws move from the partially closed positionto the closed position.
 20. A surgical stapler for applying a suture totissue, the surgical stapler comprising: an elongated shaft having adistal end and a proximal end; an end effector having first and secondjaws configured to move between an open position and a closed position;a drive member configured to translate distally through the end effectorto apply staples and a suture to tissue, the drive member comprises acutting element and at least one inclined surface a link member coupledto the first and second jaws and configured to rotate about at least onepivot pin to open and close the jaws, wherein the link member comprisesat least one drive pin; wherein the end effector comprises a drive pinslot for receiving the drive pin; and wherein distal translation of thedrive member causes the inclined surface to engage the drive pin andtranslate the drive pin through the drive pin slot to move the jaws fromthe open position to the closed position.